Physical, functional and personal variables affecting shoulder complaints in healthcare workers.

BACKGROUND: Work related shoulder disorders adversely affect the quality of life and lead to increased costs related to decreased productivity and injury treatment. Therefore, understanding the relationship between strength, upper extremity function and work ability contributes to the development of interventions aimed to improve the well-being of healthcare workers. OBJECTIVE: Correlate shoulder abduction and handgrip strength with upper extremity function and work ability in healthcare workers with shoulder complaints. METHODS: 67 workers with shoulder pain in the last year were assessed by Disability of Arm, Shoulder and Hand (QuickDASH), Work Ability Index (WAI), isokinetic shoulder strength and isometric handgrip strength dynamometers. Data were analysed with Spearman's Correlation Coefficient (ρ= 0.05), SPSS 20.0 ®. RESULTS: 52% males, mean age 48.4 years, 42% physically active, most administrative and general services workers. Low correlation between handgrip strength and QuickDASH (r=-0.359; p = 0.004); low correlation between handgrip strength and WAI (r = 0.359; p = 0.003) and between shoulder abduction strength and the QuickDASH (r = -0.267; p = 0.049); no significant correlation between shoulder abduction strength and WAI (r = 0.001; p = 0.997). CONCLUSIONS: Handgrip and shoulder abduction strength were inversely associated with upper extremity dysfunction. Shoulder abduction strength was associated with work ability. The inclusion of strength assessment in workers is important to guide strategies to prevent musculoskeletal disorders.

Exploration of outcome measures for assessing orthotic intervention in upper extremity peripheral nerve injuries: 2 case reports.

In upper extremity peripheral nerve injuries, orthotic intervention has been used as a valuable device to restore function. However, there is lacking evidence to support it. The purpose of this study was to explore the application of body function's outcome measures for orthotic intervention evaluation in patients with peripheral nerve injury. Two participants sustaining a peripheral nerve injury who underwent orthotic intervention were assessed: subject 1 was a 25-year-old man with ulnar and median nerve injury presenting with a composite claw; subject 2, a 28-year-old man with radial nerve injury presenting with a dropped wrist. Strength, range of motion, and electromyography were measured in 2 conditions: wearing the orthosis and without it. The Jamar, Pinch Gauge, a 3D motion capture system (Optitrack-NaturalPoint), and surface electromyography (Trigno Wireless System, Delsys) were the chosen instruments. Both subjects presented differences in grip and pinch strength. In both tasks, subject 1 reached higher wrist extension while wearing the orthosis. Subject 2 reached higher wrist extension and radial deviation while wearing the orthosis. There were marked differences in both tasks for subject 2, especially the maintenance of wrist extension when wearing the orthosis. Electromyographic assessment showed higher root-mean-square values for all muscles, in both tasks for subject 1. For subject 2, a higher root-mean-square value was found for flexor carpi ulnaris during the execution of task 1 wearing the orthosis. Outcome measures of body function can quantify the impact of orthotic intervention in patients sustaining peripheral nerve injury, and therefore, they are feasible for evaluating it.

Brazilian version of the Jebsen Taylor Hand Function test: An observational cross-sectional study on standardization, reliability and normative data.

STUDY DESIGN: This is an observational cross-sectional study. BACKGROUND: To assess dexterity and hand function, it is important to use validated performance-based outcome measures, such as the Jebsen Taylor Hand Function test (JTHFT). There is no previous study that has used this test in asymptomatic individuals to establish normal values for the Brazilian population, or to assess its reliability. PURPOSE: The first aim of the study was to provide a standardized illustrated manual of the Brazilian version of the JTHFT. The second aim was to evaluate JTHFT test-retest reliability in asymptomatic adults, and the third aim was to determine normative values. METHODS: This study consists of 236 individuals aged 18-60 years, of both sexes, asymptomatic for pain or injury in the upper limbs. An illustrated manual of instructions was developed in Portuguese, test-retest reliability was assessed by determining the intraclass correlation coefficient (ICC), and to evaluate the average of the correlations between the items, the Cronbach Alpha coefficient was used. The standard error of measurements of the test and retest of the JTHFT subtasks was also performed. RESULTS: The Cronbach Alpha coefficient, resulted in acceptable average values 0.75 for the dominant hand and 0.76 for the nondominant hand. JTHFT subtests reveal moderate to excellent test-retest reliability, varying from 0.53, 95% CI: 0.39-0.64; to 0.93, 95% CI: 0.91-0.95 for the dominant hand, and for the nondominant hand 0.66, 95%: 0.57-0.74; to 0.92, 95% CI: 0.90-0.94. CONCLUSION: JTHFT is reliable for a Brazilian sample in terms of test-retest measures and can be used both in research and in clinical practice. A standardized illustrated manual of application was provided.

Physiotherapeutic approach in seamstresses with neck pain: A single-blind, randomized clinical trial.

PURPOSE: To investigate and compare the effects of therapeutic exercise, therapeutic ultrasound and photobiomodulation on pain, functionality and recruitment pattern of motor units, after a rehabilitation protocol for seamstresses with neck pain. MATERIALS AND METHODS: All 36 female, randomly divided into three groups; i)exercise control group, ii)exercise and photobiomodulation group, iii)exercise and ultrasound group. The groups were composed of sewing machine operators with complaints neck pain. Clinical evaluations: Visual analog pain scale, questionnaires Nordic Musculoskeletal Questionnaire and the International Physical Activity Questionnaire, and electromyographic evaluations of the sternocleidomastoid and upper trapezius muscles. All variables were compared before and after the protocol. For statistical analysis, the values of mean, standard deviation and standard error of the mean were used. The values obtained were compared using the One-Way ANOVA with post-hoc Tukey, and Cohen's-d, with a significance coefficient of p < 0.05. RESULTS: In the Ultrasound and laser groups there was a greater tendency to improve pain (p < 0.0001) and size of the effect on pain reduction (ultrasound = d:1.99; photobiomodulation = d:1.81). Between groups, there was a significant difference in post-treatment for the onset of right trapezius (p = 0.024) in the exercise and photobiomodulation groups (p = 0.0347). The photobiomodulation group showed pre and post-intervention differences in the left trapezius maximum onset (p = 0.010). CONCLUSION: Interventions with photobiomodulation, ultrasound, and exercise assist to pain, function, and muscular activation in seamstresses with neck pain.

Electromyography in muscle activation lumbar region in a comparison between manual therapy and photobiomodulation associated with kinesiotherapy in individuals with low back pain

INTRODUCTION: About 10 million people have low back pain (LBP) disability in Brazil. Several therapies are used to treat this condition, such as kinesiotherapy, manual therapy (MT), and photobiomodulation (PBM). Although the use of these methods in LBP has been investigated, studies evaluating the efficacy of the association between these techniques are still needed. OBJECTIVE: To evaluate the activation of the lumbar region muscles by PBM or MT associated with kinesiotherapy for the treatment of LBP. METHODS: Twenty individuals with chronic LBP were randomlydivided into two groups. The first group (MT) received vertebral mobilization associated with a kinesiotherapy exercise program. The second group (830nm-PBM) received PBM associated with the exercise program, twice a week for 8 weeks. Evaluation of pain perceived was performed by the visual analogic scale (VAS), lumbar disability by the Oswestry questionnaire, muscle strength by strain gauge, and activation through surface electromyography (EMG). Data were collected before and after the treatment. EMG data was analyzed by MatLab®. The ANOVA two-way test was used (degree of significance p≤0.05), and the size of the effect by the Hedge test. RESULTS: Considering pain, the two groups presented a significant result (p<0.05). In muscle activation, only the multifidus was different during the side bridge (p<0.05) when compared intragroup. None of the variables were different when evaluating intergroup. CONCLUSION: Both MT and PBM associated with kinesiotherapy for 8 weeks are effective in reducing pain, and improving motor control and stability of the lumbar spine in patients with chronic LBP.

Viability of the random pattern dorsal skin flap in mice submitted to photobiomodulation and therapeutic ultrasound / Viabilidade do retalho cutâneo randômico dorsal em camundongos submetidos à fotobiomodulação e ultrassom terapêutico

INTRODUCTION: The skin flap is a surgical technique widely used in clinical practice and generally presents postoperative complications. Therefore, elucidating interventions that assist in tissue conservation is essential. Photobiomodulation (PBM) and therapeutic ultrasound (TUS) are non-invasive alternatives for assisting tissue repair, however, there is no consensus on the parameters used. OBJECTIVE: To describe the effectiveness of the different parameters of PBM and TUS in the viability of the dorsal random pattern skin flap in mice. METHODS: Fifty-five Swiss mice were used, distributed in eleven groups. The animals were submitted to surgical technique including revascularization of the area limited through a plastic barrier (polyester/polyethylene) with the same dimension as the flap. PBM or TUS was applied for five consecutive days. Photographic and thermographic recordings were performed with Cyber-Shot DSC-P72 and FlirC2 cameras and analyzed using the ImageJ® and FLIR Tools software, respectively. In the statistical analysis, the data were submitted to the GraphPad Prism® 8.0 software. Analysis of variance (ANOVA Two-way) and Tukey's post-test was performed, considering 5% significance level. RESULTS: Groups 5 (PBM830 nm; 10 J/cm²) and 6 (TUS 3 MHz; 0.4 W/cm²) showed percentages of viable tissue significantly higher on the third and fifth day of the experiment, when compared to the other groups. The temperature decreased significantly in group 1 when compared to the others in the postoperative period. CONCLUSION: The continuous TUS at 3 MHz and PBM 830 nm were more effective in improving the viability of the dorsal random pattern skin flap in mice.

INTRODUÇÃO: O retalho cutâneo é uma técnica cirúrgica amplamente empregada na prática clínica e comumente apresenta complicações pós-operatórias. Portanto, elucidar intervenções que auxiliem na conservação do tecido são fundamentais. A fotobiomodulação (FBM) e o ultrassom terapêutico (UST) são alternativas não invasivas que auxiliam no reparo tecidual, contudo, ainda não há consenso sobre os parâmetros a serem utilizados. OBJETIVO: Descrever a efetividade dos diferentes parâmetros da FBM e do UST na viabilidade do retalho cutâneo randômico dorsal em camundongos. MÉTODOS: Utilizou-se 55 camundongos Swiss, distribuídos em onze grupos. Os animais foram submetidos à técnica cirúrgica com a revascularização da área limitada através de uma barreira plástica (poliéster/polietileno) da mesma dimensão do retalho. Aplicou-se a FBM ou UST durante cinco dias consecutivos. O registro fotográfico e termográfico foi realizado com as câmeras Cyber-Shot DSC-P72 e FlirC2, sendo posteriormente analisados nos softwares ImageJ® e FLIR Tools, respectivamente. Na análise estatística, os dados foram submetidos ao software GraphPad Prism® 8.0 e ao teste Shapiro-Wilk para a análise da normalidade. Realizou-se a análise de variância (ANOVA Two-way) e pós-teste de Tukey, com nível de significância de 5%. RESULTADOS: Os grupos 5 (FBM 830 nm; 10 J/cm²) e 6 (UST 3 MHz; 0,4W/cm²) apresentaram porcentagens de tecido viável significativamente maiores no terceiro e quinto dia do experimento. A temperatura reduziu significativamente no grupo-1 quando comparado aos demais no pós-operatório. CONCLUSÃO: O UST contínuo a 3 MHz e FBM 830 nm, foram mais eficazes melhorando a viabilidade a do retalho cutâneo randômico dorsal em camundongos.

Psychometric properties of the Brazilian short-version of the Northwick Park Neck Pain Questionnaire.

OBJECTIVE: To translate, cross-culturally adapt and assess measurement properties of the translated version of the Northwick Park Neck Pain Questionnaire into Brazilian Portuguese. DESIGN: Cross-sectional study. SETTINGS: University healthcare facility and online. PARTICIPANTS: People with chronic neck pain (n = 178). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Participants answered the translated version of Northwick Park Neck Pain Questionnaire, the Neck Disability Index, the Numerical Rating Scale for pain, the Tampa Scale for Kinesiophobia and the Pain Catastrophizing Scale. Seven to ten days after that, a subset of 84 participants answered the Northwick Park Neck Pain Questionnaire again. The structural (exploratory and confirmatory factor analyses) and construct validities, internal consistency, reliability and concordance were assessed. Level of significance was set at 5%. RESULTS: Participants' (35.6 ± 13.5 years old) with symptoms duration of 54.4 ± 60.4 months scored 25.5 ± 14.0 on the Brazilian Northwick Park Neck Pain Questionnaire and 11.9 ± 5.8 on the Neck Disability Index. The structural analysis showed that the short version of the Northwick Park Neck Pain Questionnaire has an adequate structure to measure disability due to neck pain. Correlations with other questionnaires were between 0.268 and 0.678, Cronbach's alfa was 0.76, intraclass correlation coefficient was 0.96, standard error of measurement was 2.74 and minimal detectable change was 7.60. CONCLUSION: The short version of the Northwick Park Neck Pain Questionnaire is valid and reliable to be used in patients with chronic neck pain, as it presented adequate measurement properties of structural and construct validity, reliability and concordance.

Tradução e adaptação cultural da ferramenta de avaliação de riscos ergonômicos de membros superiores ­ Hand Arm Risk Assessment Method ­ HARM-BR / Translation with cultural adaptation of the risk assessment tool for upper limbs ­ Hand Arm Risk Assessment Method HARM-BR

Lesões musculoesqueléticas nos membros superiores estão intimamente ligadas a limitações funcionais e incapacidades. Estas lesões podem estar relacionadas ao trabalho e são conhecidas como Lesões por Esforços Repetitivos (LER) ou Distúrbios Osteomusculares Relacionados ao Trabalho (DORT). A avaliação ergonômica visa detectar os fatores de riscos para o desenvolvimento das LER/DORT e assim, intervenções e/ou ações preventivas possam ser implementadas. Para isso, são necessárias ferramentas observacionais de avaliação traduzidas e validadas para que resultados fidedignos sejam alcançados. O questionário HARM 2.0 é uma ferramenta de avaliação específica que indica se há risco de lesão em diversas tarefas que utilizam majoritariamente os membros superiores durante sua jornada de trabalho. Objetivo: Conduzir a tradução e adaptação transcultural do questionário HARM 2.0 para ser usado para avaliação e prevenção de riscos de lesões relacionadas ao trabalho. Métodos: A tradução e adaptação transcultural seguiu um protocolo composto por quatro estágios: tradução, síntese, retrotradução, revisão pelo comitê de especialistas e aprovação do conteúdo pelas autoras da versão original. Resultados: O estágio inicial (Estágio I) de tradução do questionário HARM 2.0 transcorreu sem intercorrências. Com relação ao grau de dificuldade, o tradutor expert referiu facilidade ao traduzir os itens e instruções do instrumento, enquanto a tradutora leiga considerou a dificuldade como moderada. Conclusão: O instrumento HARM-BR 2.0 apresentou resultados satisfatórios no processo de tradução e adaptação transcultural, estando sua versão disponível para uso. Futuros estudos são necessários para analisar as suas propriedades de medidas para a população brasileira de trabalhadores.

Musculoskeletal injuries in the upper limbs are closely associated with limitations and disabilities. These injuries can be work-related and are known as Repetitive Strain Injuries (RSI) or Work-Related Musculoskeletal Disorders (WRMD). The ergonomic evaluation aims to detect the risk factors for the development of RSI/WRMD and, therefore, preventive or intervention strategies can be implemented. Translated and validated observational assessments are required to achieve reliable results. The HARM 2.0 questionnaire is a specific assessment tool that indicates the risk of injury in several tasks that use the upper limbs in the work environment. Objective:The objective of this study is to conduct the translation and cross-cultural adaptation of the HARM 2.0 questionnaire for the assessment and prevention of work-related injuries. Methods:Translation and cross-cultural adaptation protocol consisting of four stages: translation, synthesis, back-translation, review by the Expert Committee, and approval by the authors of the original version. Results:The initial stage (Stage I) of translation of the HARM 2.0 questionnaire was regular and had no significant issues. Regarding the difficulty, the expert translator referred that translating the HARM items and instructions was easy, whereas the lay translator considered the scale moderate. Conclusion:The scale HARM-BR 2.0 presents satisfactory results in the process of translation and cross-cultural adaptation and its version available to use. Future studies should be conducted to establish its measurement properties for the Brazilian population.

Validade de construto do teste de caminhada de 2 minutos para pacientes com amputação de membro inferior protetizados / Validez de constructo de la prueba de marcha de 2 minutos para pacientes protésicos amputados de extremidad inferior / Construct validity of the 2-minute walk test for patients with lower limb amputation using prosthesis

RESUMO Aliados da avaliação funcional, os testes de caminhada têm sido considerados confiáveis e válidos para várias populações, quantificando a capacidade funcional do indivíduo e respondendo a mudanças durante o processo de reabilitação. O objetivo deste artigo foi analisar a validade de construto do teste de caminhada de 2 minutos para pacientes com amputação de membro inferior protetizados, submetidos à reabilitação. Foi aplicado o teste de caminhada de 2 minutos em 51 pacientes maiores de 18 anos com diagnóstico clínico de amputação de membro inferior em qualquer nível e que tivessem sido submetidos à reabilitação há pelo menos seis meses no momento da avaliação, que foi correlacionada com os questionários Medida Funcional para Amputados (MFA) e os aspectos do Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), a fim de obter o coeficiente de correlação de Pearson com o nível de significância de p<0,05. Entre os participantes do estudo, 64,7% eram do sexo masculino, com média de idade de 53,4 anos; 59,92% tinham amputação de nível transtibial e a principal causa foi trauma, com 54,9%. O escore médio para os questionários foi de 63,58 pontos para a capacidade física do SF-36, e 37,14 pontos para a segunda questão do MFA. A correlação da distância percorrida no teste de caminhada de 2 minutos mostrou moderada correlação com a capacidade física do SF-36 e com a segunda questão do MFA. Os achados mostram moderada correlação entre o teste de caminhada de 2 minutos e as ferramentas subjetivas de avaliação de função utilizadas, mostrando que é um instrumento válido como medida objetiva para a população estudada.

RESUMEN Se consideran las pruebas de marcha, utilizadas en la evaluación funcional, fiables y válidas en diversas poblaciones para cuantificar la capacidad funcional del paciente y responder los cambios durante su proceso de rehabilitación. El objetivo de este estudio fue analizar la validez de constructo de la prueba de marcha de 2 minutos en pacientes con amputación protésica de miembro inferior en rehabilitación. La prueba de marcha de 2 minutos se aplicó a 51 pacientes mayores de 18 años de edad, con diagnóstico clínico de amputación de miembro inferior a cualquier nivel y que se habían sometido a rehabilitación al menos seis meses en el momento de la evaluación, lo que se correlacionó con los cuestionarios Medida Funcional para Amputados (MFA) y los ítems del Medical Outcomes Study 36-Item Short-Form Health Survey (Cuestionario de Salud, SF-36) para obtener el coeficiente de correlación de Pearson con un nivel de significancia de p<0,05. El 64,7% de los participantes eran varones, con edad media de 53,4 años; el 59,92% tenía amputación transtibial, y la principal causa fue el traumatismo en el 54,9%. La puntuación media de los cuestionarios fue de 63,58 puntos para la capacidad física del SF-36; y para la pregunta dos del MFA, 37,14 puntos. La correlación de la distancia recorrida en la prueba de marcha de 2 minutos fue moderada para la capacidad física del SF-36 y para la pregunta dos del MFA. Los hallazgos muestran una correlación moderada entre la prueba de marcha de 2 minutos y las herramientas subjetivas de evaluación de la función utilizada, comprobando su validez como medida objetiva para la población estudiada.

ABSTRACT Allied to functional assessment, walking tests have been reported to be reliable and valid for several populations, quantifying an individual's functional capacity and responding to changes during the rehabilitation process. This study aims to analyze the construct validity of the 2-minute walk test for patients with prosthetic lower limbs undergoing rehabilitation. A total of 51 patients aged over 18 years underwent the 2-minute walk test. These individuals had a clinical diagnosis of lower limb amputation at any level and had undergone rehabilitation at least six months at the time of assessment, which was correlated with the Functional Measure for Amputees (FMA) questionnaires and the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) aspects to obtain the Pearson Correlation Coefficient with a significance level of p<0.05. Among the participants, 64.7% were male, with a mean age of 53.4 years, 59.92% had transtibial amputation and the main cause was trauma (54.90%). The average score for the questionnaires was 63.58 points for the Physical Capacity of the SF-36 and 37.14 points for question two of the FMA. The correlation of the distance walked in the 2-minute walk test showed a moderate correlation for the Physical Capacity of the SF-36 and a moderate correlation for question two of the FMA. The outcomes show a moderate correlation between the 2-minute walk test and the subjective function assessment tools used, showing that it is valid as an objective measure for the population studied.

Effects of photobiomodulation on different application points and different phases of complex regional pain syndrome type I in the experimental model.

BACKGROUND: Complex regional pain syndrome type I (CRPS-I) consists of disorders caused by spontaneous pain or induced by some stimulus. The objective was to verify the effects of photobiomodulation (PBM) using 830 nm wavelength light at the affected paw and involved spinal cord segments during the warm or acute phase. METHODS: Fifty-six mice were randomized into seven groups. Group (G) 1 was the placebo group; G2 and G3 were treated with PBM on the paw in the warm and acute phase, respectively; G4 and G5 treated with PBM on involved spinal cord segments in the warm and acute phase, respectively; G6 and G7 treated with PBM on paw and involved spinal cord segments in the warm and acute phase, respectively. Edema degree, thermal and mechanical hyperalgesia, skin temperature, and functional quality of gait (Sciatic Static Index [SSI] and Sciatic Functional Index [SFI]) were evaluated. RESULTS: Edema was lower in G3 and G7, and these were the only groups to return to baseline values at the end of treatment. For thermal hyperalgesia only G3 and G5 returned to baseline values. Regarding mechanical hyperalgesia, the groups did not show significant differences. Thermography showed increased temperature in all groups on the seventh day. In SSI and SFI assessment, G3 and G7 showed lower values when compared to G1, respectively. CONCLUSIONS: PBM irradiation in the acute phase and in the affected paw showed better results in reducing edema, thermal and mechanical hyperalgesia, and in improving gait quality, demonstrating efficacy in treatment of CRPS-I symptoms.

Validade de construto do Functional Impairment Test-Hand and Neck/Shoulder and Arm (FIT-HANSA) para trabalhadores com queixas no membro superior de um hospital terciário / Construct validity of the Functional Impairment Test-Hand and Neck/Shoulder and Arm (FIT-HANSA) for workers with upper limb complaints of a tertiary hospital

O Functional Impairment Test-Hand and Neck/Shoulder/Arm (FIT-HaNSA) é um instrumento que avalia a resistência à fadiga e o desempenho do membro superior por meio de funções motoras grossas comumente utilizadas no dia a dia. Objetivo: Analisar a validade de construto do FIT-HaNSA em trabalhadores com sintomas no membro superior, por meio da correlação entre a resistência à fadiga do segmento com os escores de força muscular do ombro, cotovelo e mão, com a capacidade para o trabalho (ICT) e com a disfunção do membro superior (QUICK DASH-Br). Métodos: Trinta e nove trabalhadores de um hospital terciário com idade média de 42,9 anos (DP13,29) foram recrutados. Os instrumentos de medida Isocinético Biodex System 4 Pro™, dinamômetro de preensão palmar JAMAR®, QuickDASH-Br e ICT foram aplicados e correlacionados com o FIT-HaNSA. O Coeficiente de Correlação de Pearson (r) foi utilizado para quantificar a associação entre os instrumentos. Resultados: O FIT-HaNSA apresentou de fraca a moderada correlação entre a força muscular do ombro, cotovelo e mão (r= 0,18 ­ 0,58), porém significativas para ombro e mão. A associação entre o FIT-HaNSA com o QuickDASH-Br e ICT se mostraram fracas (r= -0,38 e 0,21). Conclusão: Nosso estudo forneceu evidências preliminares com relação às relações esperadas e validade do FIT-HaNSA como instrumento de medida para a avaliação da fadiga e desconforto em trabalhadores com queixas no membro superior

The Functional Impairment Test-Hand and Neck/Shoulder/Arm (FIT-HaNSA) is an instrument that assesses fatigue resistance and upper limb performance through thick motor functions commonly used in everyday life. Objective: To analyze the construct validity of the FIT-HaNSA in workers with symptoms in the upper limb, through the correlation between the fatigue resistance of the segment with the muscle strength scores of the shoulder, elbow and hand, with the ability to work (ICT) and with upper limb dysfunction (QUICK DASH-Br). Methods: Thirty-nine workers from a tertiary hospital with an average age of 42.9 years (SD13.29) were recruited. The Biodex System 4 Pro ™ isokinetic measurement instruments, JAMAR® handgrip dynamometer, QuickDASH-Br and ICT were applied and correlated with FIT-HaNSA. Pearson's correlation coefficient (r) was used to quantify the association between the instruments. Results: FIT-HaNSA showed a weak to moderate correlation between the muscular strength of the shoulder, elbow and hand (r= 0.18 - 0.58), but significant for the shoulder and hand. The association between FIT-HaNSA with QuickDASH-Br and ICT was weak (r= -0.38 and 0.21). Conclusion: Our study provided preliminary evidence regarding the expected relationships and validity of FIT-HaNSA as a measurement tool for the assessment of fatigue and discomfort in workers with complaints in the upper limb

High energy photobiomodulation therapy in the early days of injury improves sciatic nerve regeneration in mice / Aplicação de alta energia da terapia de fotobiomodulação nos primeiros dias de lesão otimiza a regeneração de nervo ciático em camundongos

INTRODUCTION: Different studies have evaluated the effects of electrophysical agents on regeneration after peripheral nerve injury. Among them, the most used in clinical and experimental research is photobiomodulation therapy (PBMT). OBJECTIVE: To analyze the effect of standard energy (16.8 J) of PBMT on peripheral nerve regeneration, applied at different periods after sciatic nerve injury in mice. METHODS: Thirty male Swiss mice were divided into six groups: naive; sham; control; LLLT-01 (660 nm, 16.8 J of total energy emitted in 1 day); LLLT-04 (660 nm, 4.2 J per day, 16.8 J of total energy emitted in 4 days); LLLT-28, (660 nm, 0.6 J per day, 16.8 J of total energy emitted over 28 days). The animals were evaluated using thermal hyperalgesia, Sciatic Functional Index (SFI), and Static Sciatic Index (SSI). Data were obtained at baseline and after 7, 14, 21, and 28 days after surgery. RESULTS: For the SFI and SSI, all groups showed significant differences compared to the control group, and the LLLT-04 group presented the best results among those receiving PBMT. In the assessment of thermal hyperalgesia, there was a significant difference in the 14th day of evaluation in the LLLT-04 group. CONCLUSION: The application of 16.8 J was useful in sciatic nerve regeneration with an improvement of hyperalgesia, with higher efficacy when applied in four days (4.2 J/day).

INTRODUÇÃO: Estudos avaliaram os efeitos de diferentes terapias aplicadas após lesão nervosa periférica, com o intuito de promover a regeneração local. Dentre elas, a mais utilizada em pesquisa clínica e experimental é a terapia de fotobiomodulação (TFBM). OBJETIVO: Analisar o efeito da fotobiomodulação (16,8 J) na regeneração nervosa periférica, aplicada em diferentes regimes após a lesão do nervo ciático em camundongos. MÉTODOS: Foram utilizados trinta camundongos machos (Swiss) divididos em: naive; sham; controle; LBI-01 (660 nm, 16,8 J de energia total emitida em 1 dia); LBI-04 (660 nm, 4,2 J por dia, 16,8 J de energia total emitida em 4 dias); LBI-28, (660 nm, 0,6 J por dia, 16,8 J de energia total emitida durante 28 dias). Os animais foram avaliados utilizando a hiperalgesia térmica, Índice Funcional do Ciático (IFC) e Índice estático do ciático (IEC). Os dados foram obtidos na linha de base e após 7, 14, 21, e 28 dias após a cirurgia. RESULTADOS: Para o IFC e IEC, todos os grupos mostraram um aumento no valor e diferenças significativas em relação ao grupo de controle, e o grupo LBI-04 apresentou os melhores resultados, alcançando valor basal no 21° dia dentre os que foram submetidos a TFBM. Na avaliação da hiperalgesia térmica, houve aumento do tempo de resposta com diferença significativa no 14° dia de avaliação no grupo LBI-04. CONCLUSÃO: A aplicação de 16,8 J foi eficaz na regeneração do nervo ciático quando distribuída ao longo dos 4 primeiros dias pós-lesão, com dose diária de 4,2 J/ponto.

Enhancing function after radial nerve injury with a high-profile orthosis and a bio-occupational orthotic framework.

STUDY DESIGN: Case report. INTRODUCTION: Radial nerve injury can cause severe functional impairment due to paralysis of wrist and digit extensors. Various orthotic designs have been described, including static, dynamic, and tenodesis. All provide wrist stabilization or extension assistance. Some, but not all, also provide extension assistance to the wrist, thumb, and fingers. PURPOSE AND METHODS: This article tells the story of Max, a 27-year-old male university student, who sustained a radial nerve injury after a left humeral shaft fracture. He was treated at a Brazilian tertiary hospital, where the choice of thermoplastics and dynamic components resulted in limited options for orthotic fabrication. Max was provided with custom-molded static wrist orthosis and a bulky, older style, high-profile dynamic forearm-based wrist-finger-thumb assistive-extension orthosis. RESULTS AND DISCUSSION: Grip strength and functional status improved, and Max was completely satisfied because with the dynamic orthosis, he could play the guitar again, which was his favorite activity. CONCLUSION: Max's story illustrates that a convenient functionally oriented orthotic intervention can be performed even in resource-limited environments by following the client-centered bio-occupational orthotic framework proposed by McKee and Rivard. This framework addresses the client's biological needs (addressing paralyzed muscles and maintaining length of soft tissues) and occupational/functional needs.

Validade, confiabilidade e responsividade da versão brasileira do questionário Patient Specific Functional Scale (PSFS-Br) nas lesões do membro superior / Validity, reliability and responsiveness of the Brazilian version of the Patient Specific 6Functional Scale (PSFS-Br) in upper limb lesions

Lesões podem gerar consequências funcionais e mudanças de vida para o indivíduo. Além do exame físico, a aplicação de questionários de autorrelato são fundamentais para a tomada de decisão, determinação do prognóstico e avaliação da eficácia do tratamento. O Patient Specific Functional Scale (PSFS) é um questionário individual que avalia o estado funcional do indivíduo. Suas vantagens propostas incluem sua ampla aplicabilidade, facilidade de administração, e adequada responsividade para análise da evolução funcional. Entretanto, esta escala ainda não está disponível na versão em português-brasileiro. Objetivo: Realizar a tradução e adaptação transcultural do questionário e analisar sua validade, confiabilidade e responsividade em pacientes com lesões do membro superior. Métodos: O PSFS-Br foi desenvolvido usando diretrizes padronizadas e o processo de tradução ocorreu em 5 etapas. Após a versão definitiva, 100 pacientes com lesões do membro superior foram recrutados e responderam o PSFS-Br, Quick-DASH-Br a Escala Visual Analógica em três ocasiões. Resultados: A compreensão adequada do instrumento pela população alvo resultou em boa validade de face. O PSFS-Br, quando comparado ao QuickDASH-Br, apresentou validade de construto fraca r = -0,36, excelente confiabilidade teste-reteste (ICC = 0,91) e apresentou alta responsividade com Tamanho do Efeito(TE) = 1,85, Média da resposta Padronizada (MRP) = 2, 75, Erro padrão de medida (EPM) = 0,36 e Minima diferença dectável (MDD) = 1,5. Conclusão: Este estudo demostrou que o PSFS-Br é uma ferramenta válida, confiável e responsiva para pacientes brasileiros com lesões do membro superior.

Injuries can lead to functional consequences and changes in the lives of individuals. In addition to physical examination, a self-report questionnaire application is critical for decision making, prognosis determination, and treatment evaluation. The Patient Specific Functional Scale (PSFS) is an individual questionnaire that evaluates the individuals functional status and its advantages, which can be applied, ease of administration and responsive. However, this scale is not yet available in the Portuguese-Brazilian version. Objective: To perform a translation and cross-cultural adaptation of the questionnaire and to analyze its validity,reliability and responsiveness in patients with upper limb injuries. Methods: PSFS-Br was developed using standardized guidelines and the translation process took place in 5 steps. After a definitive version, 100 patients with upper limb injuries were recruited and answered by PSFS-Br, Quick-DASH-Br and Visual Analogue Scale on three occasions. Results: Proper understanding of the instrument by the target population resulted in good face validity. PSFS-Br, when compared to QuickDASH-Br, shows poor construct validity r = -0.36, excellent retest test reliability (ICC = 0.91) and high responsiveness with Effect Size (ES) = 1.85, Standand response mean (SRM) = 2.75, Standard Error of Measure (SEM) = 0.36 and Minimal Chande Diference (MCD) = 1.5. Conclusion: PSFS-Br is a valid, reliable and responsible tool for Brazilian patients with upper limb injuries.

Functional, motor, and sensory assessment instruments upon nerve repair in adult hands: systematic review of psychometric properties.

BACKGROUND: Outcome after nerve repair of the hand needs standardized psychometrically robust measures. We aimed to systematically review the psychometric properties of available functional, motor, and sensory assessment instruments after nerve repair. METHODS: This systematic review of health measurement instruments searched databases from 1966 to 2017. Pairs of raters conducted data extraction and quality assessment using a structured tool for clinical measurement studies. Kappa correlation was used to define the agreement prior to consensus for individual items, and intraclass correlation coefficient (ICC) was used to assess reliability between raters. A narrative synthesis described quality and content of the evidence. RESULTS: Sixteen studies were included for final critical appraisal scores. Kappa ranged from 0.31 to 0.82 and ICC was 0.81. Motor domain had manual muscle testing with Kappa from 0.72 to 0.93 and a dynamometer ICC reliability between 0.92 and 0.98. Sensory domain had touch threshold Semmes-Weinstein monofilaments (SWM) as the most responsive measure while two-point discrimination (2PD) was the least responsive (effect size 1.2 and 0.1). A stereognosis test, Shape and Texture Identification (STI), had Kappa test-retest reliability of 0.79 and inter-rater reliability of 0.61, with excellent sensibility and specificity. Manual tactile test had moderate to mild correlation with 2PD and SWM. Function domain presented Rosén-Lundborg score with Spearman correlations of 0.83 for total score. Patient-reported outcomes measurements had ICC of 0.85 and internal consistency from 0.88 to 0.96 with Patient-Rated Wrist and Hand Evaluation with higher score for reliability and Spearman correlation between 0.38 and 0.89 for validity. CONCLUSIONS: Few studies included nerve repair in their sample for the psychometric analysis of outcome measures, so moderate evidence could be confirmed. Manual muscle test and Rotterdam Intrinsic Hand Myometer dynamometer had excellent reliability but insufficient data on validity or responsiveness. Touch threshold testing was more responsive than 2PD test. The locognosia test and STI had limited but positive supporting data related to validity. Rosén-Lundborg score had emerging evidence of reliability and validity as a comprehensive outcome following nerve repair. Few questionnaires were considered reliable and valid to assess cold intolerance. There is no patient-reported outcome measurement following nerve repair that provides comprehensive assessment of symptoms and function by patient perspective.

Comparative effect of photobiomodulation associated with dexamethasone after sciatic nerve injury model.

To analyze the effect of photobiomodulation and dexamethasone on nerve regeneration after a sciatic nerve crushing model. Twenty-six Swiss mice were divided into the following groups: naive; sham; injured, low-level laser therapy (LLLT) (660 nm, 10 J/cm2, 0.6 J, 16.8 J total energy emitted during the 28 days of radiation, 20 s, for 28 days); dexamethasone (Dex) (local injection of 2 mg/kg for 10 consecutive days); and LLLT group associated with Dex (LLLT/Dex), with the same parameters of the other groups. For nerve injury, a portable adjustable pinch was used. The animals were evaluated using the Sciatic Functional Index (SFI) and Sciatic Static Index (SSI). The results obtained were evaluated with Image J™ and Kinovea™. Data and images were obtained at baseline and after 7, 14, 21, and 28 days after surgery. The evaluation of hyperalgesia, using Hargreaves, and behavior through the open field was also performed. In functional and static analysis, all groups presented significant differences when compared to the injured group. In the analysis of the SSI results, the group treated with both LLLT and dexamethasone was more effective in improving the values of this parameter, and in the SFI, the laser-treated group obtained better results. In the evaluation through the open field and the Hargreaves, there was no difference. The application of LLLT and dexamethasone was effective in nerve regeneration according to the results and was more effective when LLLT was associated with dexamethasone than in LLLT alone for the SSI.

Influência da órtese estática de punho na atividade muscular e amplitude de movimento de ombro e cotovelo durante uma tarefa funcional: estudo biomecânico / Influencia de la ortesis estática de puño en la actividad muscular y la amplitud de movimiento de hombro y codo durante una tarea funcional: el estudio biomecánico / Influence of static wrist orthosis on muscle activity and shoulder and elbow range of motion during a functional task: a biomechanical study

RESUMO As órteses são recursos terapêuticos indicados para proteger, corrigir deformidades ou auxiliar em certas funções; porém, seu uso pode acarretar compensações proximais no ombro. O objetivo deste estudo é avaliar a influência da órtese estática dorsal do punho, em 30° de extensão na biomecânica do ombro e cotovelo, em 25 voluntários assintomáticos durante uma tarefa funcional. Os dados da amplitude de movimento e ativação muscular foram adquiridos de forma sincronizada e simultânea durante parte do teste funcional Elui, que simula alimentação, dividida em alcance, deslocamento e liberação, de uma jarra, nas condições sem e com órtese. Para possibilitar a comparação entre os diferentes sujeitos e músculos, os dados foram analisados pela integral do sinal EMG de cada músculo e, para análise cinemática, foram construídos sistemas de coordenadas de marcadores pré-definidos. Os sinais captados foram filtrados e processados por um software personalizado, e utilizou-se o teste t para amostras pareadas - software SPSS, p<0,05. Notou-se um aumento significativo da ativação dos músculos deltoide anterior e peitoral maior na fase de alcance, e trapézio superior, deltoide anterior e posterior na fase de liberação com a órtese. A cinemática mostrou aumento significativo na amplitude de movimento na abdução do ombro, flexão do cotovelo e pronação do antebraço na fase de deslocamento, e dos movimentos extensão do ombro e flexão do cotovelo na fase de liberação. Nossos achados sugerem que o uso da órtese estática do punho durante a execução de uma tarefa pode acarretar compensações, com predomínio da ativação dos músculos mais proximais do membro superior.

RESUMEN Las ortesis son recursos terapéuticos indicados para proteger, corregir deformidades o auxiliar en ciertas funciones; sin embargo, su uso puede acarrear compensaciones proximales en el hombro. El objetivo de este estudio, entonces, es evaluar la influencia de la ortesis estática dorsal del puño, en 30° de extensión en la biomecánica del hombro y codo, en 25 voluntarios asintomáticos durante una tarea funcional. Los datos de la amplitud de movimiento y de la activación muscular han sido adquiridos de manera sincronizada y simultánea durante parte de la prueba funcional Elui, que simula la alimentación, dividida en alcance, desplazamiento y liberación, de un jarrón, en las condiciones sin y con ortesis. Para posibilitar la comparación entre los distintos individuos y músculos, los datos han sido analizados por la integral de la señal EMG de cada músculo y, para el análisis cinemático, han sido construidos sistemas de coordinadas de marcadores predefinidos. Las señales captadas han sido filtradas y procesadas por un software personalizado, y se ha utilizado la prueba t para muestras pareadas - software SPS®, p<0,05. Se ha visto un incremento significativo de la activación de los músculos deltoide anterior y pectoral más grande en la etapa de alcance, y trapecio superior, deltoide anterior y posterior en la etapa de liberación con la ortosis. La cinemática ha mostrado incremento significativo en la amplitud de movimiento en la abducción del hombro, flexión del codo y pronación del antebrazo en la etapa de desplazamiento, y de los movimientos extensión del hombro y flexión del codo en la etapa de liberación. En nuestros hallazgos se sugieren que el uso de la ortosis estática del puño durante la ejecución de una tarea puede acarrear compensaciones, con predominio de la activación de los músculos más proximales del miembro superior.

ABSTRACT Orthoses are therapeutic resources that are appropriate to protect and remedy deformities or to help in the performance of certain functions; however, its use may lead to proximal compensations in the shoulder. Thus, this study aims to evaluate the influence of dorsal static 30° extension orthoses on the shoulder and elbow biomechanics in 25 asymptomatic individuals during a functional task. The range of motion and muscle activation was collected by simultaneous and synchronized analysis during the Elui functional test related to feeding, under the conditions with and without the orthosis. In order to allow a comparison of the different subjects and muscles, the data were analyzed by EMG signal of each muscle and, for kinematic analysis, pre-defined marker coordinate systems were constructed. The captured signals were filtered and processed by custom software, and the t-test for paired samples, SPSS® software, p<0.05, was used. We found significant increase in activation of the anterior deltoid and pectoralis major muscle in the reach phase and upper trapezius, anterior and posterior deltoid in the release phase with the orthosis. The kinematic analysis showed a significant increase in the range of motion of shoulder abduction movements, elbow flexion and pronation in the displacement phase and shoulder extension and elbow flexion movements in the release phase. Our findings suggest that the use of static wrist orthosis while performing a task can lead to compensations, with predominant activation of more proximal muscles of the upper limb.

Fadiga dos músculos extensores do punho diminui a força de preensão palmar / La fatiga de los músculos extensores de muñeca disminuye la fuerza de prensión palmar / Fatigue of the wrist extensor muscles decreases palmar grip strength

RESUMO O objetivo deste estudo foi avaliar os efeitos de um protocolo de fadiga dos músculos extensores de punho na força de preensão e da pinça lateral através da dinamometria e eletromiografia de superfície (EMG). Foram selecionados 40 indivíduos do sexo masculino, divididos em dois grupos: preensão ou pinça lateral. O protocolo de fadiga foi baseado no teste de 1 Repetição Máxima (1-RM), seguido da realização do movimento de extensão de punho repetidas vezes com carga de 75% da 1-RM. Os voluntários realizaram as tarefas de preensão ou pinça lateral associadas à dinamometria. A EMG foi realizada para ambos os grupos, analisando o comportamento, segundo o protocolo, pela frequência mediana (FM) do extensor radial do carpo (ERC), do extensor ulnar do carpo (EUC) e do flexor superficial dos dedos (FD). A dinamometria de preensão ou pinça lateral e a EMG foram realizadas antes e após o protocolo de fadiga para ambos os grupos. O protocolo de fadiga foi eficaz na diminuição da força de preensão palmar (43,5±3,85 kgf inicial e 36,50±5,1 kgf final) e da pinça lateral (10,26±1,01 kgf inicial e 8,54±0,86 kgf final), bem como na diminuição da FM, sugerindo uma condição de fadiga do EUC no grupo preensão. Os achados do presente estudo possibilitam relacionar a fadiga dos extensores de punho à diminuição de força em atividades funcionais, como a preensão, o que pode implicar em disfunções musculoesqueléticas do membro superior.

RESUMEN En este estudio se evalúa los resultados de un protocolo de fatiga de los músculos extensores de muñeca en la fuerza de presión y de pinza empleando la dinamometría y la electromiografía de superficie (EMG). Se eligieron a cuarenta hombres, los cuales fueron divididos en dos grupos: el de presión y el de pinza lateral. Se basó el protocolo de fatiga en la prueba de 1 Repetición Máxima (1RM), y se realizó el movimiento de extensión de muñeca muchas veces con carga del 75% de la 1RM. Los participantes realizaron la tarea de prensión o de pinza lateral asociada a la de dinamometría. La EMG fue realizada por ambos grupos, en los que se evaluó el comportamiento ante el protocolo de la frecuencia mediana (Fm) del extensor radial del carpo (ERC), del extensor cubital del carpo (ECC) y del flexor superficial de los dedos (FD). Se realizaron la dinamometría de presión o de pinza lateral y la EMG antes y después del protocolo de fatiga en ambos grupos. El protocolo de fatiga fue eficaz en la disminución de la fuerza de presión palmar (43,5±3,85 kgf inicial y 36,50±5,1 kgffinal) y de pinza lateral (10,26±1,01 kgf inicial y 8,54±0,86 kgf final), así como en la disminución de la Fm, lo que demuestra una condición de fatiga del ECC en el grupo de presión. Los resultados de este estudio permiten relacionar la fatiga de los extensores de muñeca a la disminución de fuerza en las actividades funcionales, lo que puede causar trastornos musculoesqueléticos del miembro superior.

ABSTRACT The objective of this study was to evaluate the effects of a wrist extensor muscles fatigue protocol at the handgrip and lateral pinch strength through dynamometry and surface electromyography (EMG). Forty male individuals were divided into two groups: handgrip and lateral pinch group. The fatigue protocol was based on the 1 Maximal Repetition (1-MR) test, followed by wrist extension movement repeated multiple times with a load of 75% of 1-MR. The volunteers performed hand grip and lateral pinch with a dynamometer. Surface EMG was performed by both groups to analyze the behavior of median frequency (MF) during a fatigue protocol. The muscles extensor carpi radialis longus and brevis, extensor carpi ulnaris, extensor digitorum and flexor digitorum superficialis were analyzed. The strength and EMG evaluations were carried out before and after the fatigue protocol in both groups. The fatigue protocol was effective on hand grip strength reduction (43.5±3.85 kgf in baseline and 36.50±5.1 kgf final) and lateral pinch strength reduction (10.26±1.01 kgf in baseline and 8.54±0.86 kgf final) (p<0.05, 95% CI). At the EMG analysis, using median frequency, an ulnaris carpal extensor muscle fatigue at the handgrip group was evidenced. The findings indicate that wrist extensors fatigue can decrease the strength in functional activities such as handgrip, resulting in upper limb dysfunctions.